11% of Pennsylvanians are uninsured. Now that the Supreme Court has upheld most of the Affordable Care Act, that may change, as well as many other aspects of the way health care is delivered.

When Governor Tom Corbett was Pennsylvania Attorney General in 2010, he was part of an unsuccessful lawsuit calling for a repeal of the act requiring Americans to buy health care or pay a penalty.

The Court ruled that Congress can expand Medicaid but it cannot strip states of Medicaid funds if they fail to expand- meaning they cannot give states additional money but they cannot take away money they currently receive.

800,000 Pennsylvanians would join the 2 million already-enrolled Medicaid patients under this expansion, according to the Department of Public Welfare. The expansion would cover individuals and families whose income is below 133% of the federal poverty level.

Arthur Hellman, a professor at the University of Pittsburgh's School of Law, specializes in constitutional law. He said while the law won't fully go into effect until 2014, it has immediate ramifications for insurers and hospitals.

"The law is going to go into effect and everybody can start preparing for it. Insurance companies can start preparing for it and doctors and hospitals can start preparing for it," said Hellman. "So that is pretty significant from the standpoint of knowing exactly what is going to happen. Uncertainty is almost worse than almost anything else … from the standpoint of somebody who has to run a business."

Pennsylvania will have to expedite efforts to set up an online marketplace, called a health insurance exchange. The exchange will require health insurance companies to list, in plain language, exactly what they offer, allowing people to compare and contrast coverage plans. It must be in place by late 2013. The state Insurance Department received a $33 million grant to begin implementing the exchange last January, but earlier this week a spokesperson said they have not touched one penny of it.

Donald Fischer, Chief Medical Officer for Highmark, the Blue Cross Blue Shield subsidiary which insures around 3 million people in this region, said the health insurance plans they offer on the exchange will be different from the plans they currently offer.

"We believe people who will be shopping, many who have never had any health insurance before, will be very price-conscious. We often think they will be younger people who have been used to using tools like the internet," Fischer said.

He said they're glad to have clarity about what direction to take, but there are still issues in the health care system.

"We still have concerns about quality of care, about the spiraling cost of care, and know that we have to be able to address those problems, which are not completely handled by the Affordable Care Act, so there's more work to do," he said.

Since the law was passed in 2010 allowing parents to keep their dependents under the age of 26 on their health insurance, 91,000 young adults in Pennsylvania have gained health care coverage. It has also provided money to Medicare patients to help pay for prescription drugs. The law also removes lifetime limits on health benefits and makes it easier for those with pre-existing conditions to find health coverage.

A long list of local organizations and politicians have weighed in on the ruling:

Congressman Mark S. Critz (PA-12) was not pleased with the ruling.

"I disagree with the Supreme Court's decision on the individual mandate, which is why I voted to repeal it – and it is still my opinion that Congress should act swiftly to repeal the tax on medical devices, and the Independent Payment Advisory Board – an unelected board of bureaucrats who could cut benefits for seniors on Medicare," said Critz.

"I opposed the healthcare bill when it passed, but it would be wrong and irresponsible for Congress to go backwards and allow insurance companies to deny coverage to those with pre-existing conditions, to kick young adults off their parents' health insurance plans, or to re-open the 'doughnut hole' which will force seniors to pay more for medicine.

"The Supreme Court has given us guidance, and it is our responsibility to work together in a bipartisan fashion going forward."

Rep. Tim Murphy, (PA-18) reacted to the decision by calling for action.

"Now that the Supreme Court has ruled on the constitutionality of President Obama's new healthcare tax, Congress must get to work on fully repealing this bill and undoing the new tax before it goes into full effect. The bill that was rushed through Congress and signed into law was unpopular, unworkable and unsustainable. It was not designed to deliver the kind of healthcare reforms Americans want and need. Simply put, a healthcare tax is not healthcare reform," said Murphy.

"Beyond repeal of the new healthcare tax, Congress must deliberate on what is truly needed — and is constitutionally sound — to fix our healthcare system rather than just raising taxes to finance it. The American people are demanding a system that delivers the care you need, at a price a price you can afford, from a doctor you choose — without new taxes or a government takeover."

U.S. Congressman Jason Altmire (PA-04) was mixed in his response.

"I agree with today's ruling. Although I voted against the 2010 health care reform bill, I never believed, nor did I ever argue, that it would be found unconstitutional. I voted against the bill because my constituents were overwhelmingly against it, and because I believed that bill was flawed policy," said Altmire.

"Two years later, I still believe that the law does not adequately strike the balance between expanding coverage, improving quality, and lowering costs. Now that the Court has ruled, it is my hope that we can once and for all put the acrimonious political debate behind us and do what we should have been doing all along — working together in a bipartisan fashion to improve upon the law and bring down health care cost for American families, businesses, and the government."

Governor Tom Corbett today said he was disappointed in the U.S. Supreme Court ruling but said he will work hard to limit the law's negative impact on Pennsylvanians.

"It appears that the Supreme Court agreed with the lawsuit brought by myself and 12 other Attorneys General finding Obamacare unconstitutional under the Commerce Clause of the Constitution, however they did uphold the law under Congress' taxing authority,'' Corbett said.

"Despite the President's repeated assertions that this was not a tax, the Supreme Court today ruled that it is in fact a tax. Not only is it a tax, but it may turn out to be one of the largest tax increases in the history of our nation. It is a tax on our citizens that they cannot afford. It is a tax that hits our small businesses the hardest and will kill job growth.

"This law will raise healthcare costs for our families, our employers and our state,'' Corbett said. "This is a burden to all of us who work every day to recover from the recession.

State Rep. Dan Frankel, D-Allegheny, welcomed the ruling.

"I'm delighted that the Supreme Court upheld the health care law. This will put an end to insurance industry practices that may have made sense from a business perspective, but failed as health policies," Frankel said.

"Now women know they won't be charged more than men for the same insurance. People won't face losing health care coverage when they get sick. And the estimated 20 to 69 percent of Pennsylvanians who would be considered to have pre-existing conditions can't be denied health care when they need to buy it."

Republican Party of Pennsylvania Chairman Rob Gleason did not a agree with the ruling.

"While we are extremely disappointed in today's ruling, the Supreme Court decision sets the stakes for the November election. The only way to save the country from ObamaCare's budget-busting government takeover of health care is to elect a new President," Gleason said.

"Under ObamaCare, President Obama's signature legislation, health care costs continue to skyrocket, and up to 20 million Americans could lose their employer-based coverage. Meanwhile, a panel of unelected bureaucrats now has the unprecedented authority to come between elderly patients and their doctors."

"I applaud Governor Tom Corbett for his tireless efforts to fight against the federal government's massive takeover of our healthcare system in Pennsylvania. The fight now turns to the White House. We must elect a president who understands the economy, respects free enterprise, and can provide the leadership we now so desperately need. On Election Day, we must elect Mitt Romney and put America on the path toward a brighter economic future and successful health care reform."

Pennsylvania Democratic Party Chairman Jim Burn responded by saying, "Today's decision affirms the progress the American people have made toward a stronger health care system that protects middle-class families. Through health care reform Pennsylvanians have lower costs, more choices, and easier access to quality, affordable health care. Seniors have access to less expensive medicine and more opportunities to visit doctors. Young people are able to stay on their parents' insurance. People with pre-existing conditions will not be denied care. Women will no longer face gender discrimination in the health care system. These are all unquestionably positive steps for Pennsylvania and the country."

"Meanwhile, Mitt Romney and his fellow Republicans have no alternative and no plan. Led by Tea Partiers, Mitt Romney and his fellow Republicans have wrongly attacked health reform, pledging to send our country backwards. It is now time to move forward, implement the law and work together to create jobs in Pennsylvania and throughout the country."

The Pennsylvania Chapter of the National Federation of Independent Business has come out against the decision calling it a "heavy-handed individual mandate."

"While we are certainly disappointed… Clearly this mandate has now become a tax on all Americans and a broken campaign promise from President Obama not to raise taxes. We are concerned about the precedent that this will set in Congress' ability to mandate other aspects of our lives, but we will move forward from today to continue to fight, harder than ever, for real health-care reform for our membership."

"Under PPACA, small-business owners are going to face an onslaught of taxes and mandates, resulting in job loss and closed businesses. We will continue to fight for the repeal of PPACA in the halls of Congress… This day will go down in history as the day when Americans lost a part of their freedom – the freedom to choose what to buy with their own money."

This story was produced in collaboration with NPR and Kaiser Health News.